Trump Administration Declares Opioid Crisis A Public Health Emergency

According to the Centers for Disease Control and Prevention, more than 140 Americans die every day from an opioid overdose.

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Originally published on October 26, 2017 12:20 pm

Updated at 2:50 p.m. ET

President Trump declared a public health emergency to deal with the opioid epidemic Thursday, freeing up some resources for treatment. More than 140 Americans die every day from an opioid overdose, according to the Centers for Disease Control and Prevention.

"We are currently dealing with the worst drug crisis in American history," Trump said, adding, "it's just been so long in the making. Addressing it will require all of our effort."

"We can be the generation that ends the opioid epidemic," he said.

Trump also directed agency and department heads to use all appropriate emergency authorities to reduce the number of deaths caused by the opioid crisis.

Trump spoke personally about his brother Fred who struggled with alcoholism and died in his 40s. Because of him, Trump said, he had never tried alcohol or cigarettes. "He would tell me 'don't drink, don't drink,' " Trump said. "He had a very, very, very tough life because of alcohol."

The administration will also launch an ad campaign so that young people can see "the devastation and ruination [drugs cause] people and people's lives."

The move stops short of declaring the crisis a national emergency, which Trump first said in August that he would declare. He repeated that pledge this week. But the White House said it determined that declaring a public health emergency was more appropriate than a national emergency.

Dr. Andrew Kolodny, co-director of the Opioid Policy Research Collaboration at Brandeis University's Heller School, calls the announcement "very disappointing." Without funding for new addiction treatment, he says, declaring a public health emergency isn't enough. "This is not a plan," he says. "The administration still has no plan" for dealing with opioids, he says.

After taking office, Trump created a commission to study the opioid crisis, headed by New Jersey Gov. Chris Christie. In an interim report, the commission called on the president to declare a national emergency under either the Public Health Service Act or the Stafford Act. Doing so, the commission said, could free up funds for treatment, ensure wider access to the anti-overdose drug naloxone and improve monitoring of opioid prescriptions to prevent abuse.

Public health emergencies expire after 90 days, although the administration says they can easily be renewed. The designation gives the administration access to the Public Health Emergency Fund, but that fund is nearly empty.

In outlining its opioid plan, administration officials highlighted four areas. It allows expanded access to telemedicine services, giving doctors the ability to prescribe medications to treat addiction to those in remote locations. It speeds the hiring process for medical professionals working on opioids. And it allows funds in programs for dislocated workers and people with HIV/AIDS to be used to treat their addictions.

Dr. Keith Humphreys, a professor of psychiatry at Stanford University and a former adviser in the Obama administration, calls the Trump administration's response "pathetic," saying it mostly repurposes long-existing public health programs. Humphreys notes that aside from the emergency declaration, there is little that was recommended by the White House commission in the president's plan.

The commission had also recommended rapidly increasing treatment capacity for recovering addicts by granting Medicaid waivers, mandating educational initiatives at medical and dental schools to tighten opioid prescribing, and funding a program to expand access to medications used to treat addictions.

In a briefing Thursday, the administration said some of these initiatives are underway. The Food and Drug Administration has already expanded education requirements around prescribing opioids, officials said. Just this week, the FDA director told a congressional committee that the agency will begin working to promote medication-assisted treatment — using methadone, buprenorphine or naltrexone to help addicts in recovery — although that initiative doesn't carry any additional funding.

The final report of the White House's commission on opioids is due next week. On Thursday, Christie praised the president for what he called "bold action."

Christie said, "The President is showing an unprecedented commitment to fighting this epidemic and placing the weight of the Presidency behind saving lives across the country."

The biggest question mark surrounding the president's plan for addressing opioids involves money. Congress is currently spending $500 million a year on addiction treatment programs, but that money runs out next year. The administration says it will work with Congress in the budgeting process to find new money to fund addiction treatment programs. This week, a group of Democratic senators introduced a bill that would provide more than $45 billion for opioid abuse prevention, surveillance and treatment. Not coincidentally, that is the same amount of money Republican sponsors included for preventing opioid abuse in bills that would have repealed the Affordable Care Act.

Humphreys, a former official in the Office of National Drug Control Policy, says that if the president is serious about opioids, he should endorse that bill. Another option would be to restore a funding cut proposed for Substance Abuse and Mental Health Services Administration, the agency within the Department of Health and Human Services that oversees addiction treatment programs. In its 2018 budget, the Trump administration is proposing cutting the agency's budget by nearly $400 million.

Copyright 2017 NPR. To see more, visit http://www.npr.org/.

DAVID GREENE, HOST:

This is an alarming number. More than 140 Americans die every day from an opioid overdose. That's according to the CDC. And today, President Trump will make an announcement about the opioid crisis, but it's still not clear what that will entail. The president first said he would declare a national emergency in August, but the proposal has stalled. NPR's Greg Allen reports on what happened to the plan.

GREG ALLEN, BYLINE: When President Trump announced two months ago that he'd declare opioids a national emergency, like many, Dr. Andrew Kolodny expected immediate action.

ANDREW KOLODNY: If you're calling something an emergency, you expect people to act urgently and to respond as if it's an emergency.

ALLEN: Kolodny co-directs the opioid policy research collaboration (ph) at Brandeis University. He says it's been frustrating, waiting for the administration to deliver a plan for a crisis Trump first acknowledged on the campaign trail when he was running for president. After taking office, President Trump appointed a commission to study the opioid crisis, headed by New Jersey Governor Chris Christie.

In an interim report, the commission called on the president to declare a national emergency, a measure that would free up funds for treatment, ensure wider access for the anti-overdose drug naloxone and improve monitoring of opioid prescriptions to prevent abuse.

In August, days before the president said he'd declare a national emergency, Secretary of Health and Human Services Tom Price said he didn't think one was necessary. Flash forward two months, though, and Tom Price is gone. Dr. Keith Humphreys, professor of psychiatry at Stanford University and a former adviser in the Obama administration, notes that Price was not a friend to addiction treatment programs.

KEITH HUMPHREYS: When he was a congressman, he opposed the parity law, which required insurers to cover addiction treatment. He was very skeptical of methadone maintenance, which is a very good treatment for heroin addiction. So having him out of the way is a potential plus.

ALLEN: In a policy change, the director of the Food and Drug Administration yesterday told a congressional committee, the agency will begin working to promote medication-assisted treatment using methadone, buprenorphine or naltrexone to help addicts in recovery. That's significant because some states currently won't pay for some of those treatments.

Advocates will be listening for what, if anything, the president says about that - also, whether he'll use his authority to negotiate cheaper prices for treatment drugs, including naloxone. But in the president's address today, advocates say the key issue will be what he says about funding. Congress is currently spending $500 million a year on addiction treatment programs. Andrew Kolodny says to help the more than 27 million Americans abusing opioids, much more is needed. He puts the price tag at $6 billion each year.

KOLODNY: You want that opiate-addicted individual to be able to access effective outpatient treatment more easily than they can get pills, heroin or fentanyl.

ALLEN: Kolodny criticizes the Obama administration for being slow to acknowledge opioids, a crisis, he says, that began in 1996 and which the CDC declared an epidemic in 2011. President Obama's HHS Secretary, Kathleen Sebelius, agrees.

KATHLEEN SEBELIUS: Did we do enough? Probably not. Recognizing how widespread this was, what factors were contributing to it, would've been helpful a number of years ago.

ALLEN: And Sebelius says it might've prevented many overdose deaths. Sebelius notes that the Affordable Care Act and the expansion of Medicaid greatly expanded addiction treatment coverage. If President Trump is serious about tackling opioids, she says, his first step should be to stop fighting to repeal Obamacare. Greg Allen, NPR News.